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    OpenPayerBilling CodesAbnormal findings on examination of blood, without diagnosisICD-10-CM r75-inconclusive-hiv-laboratory-evidence
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    ICD-10-CM Code For Inconclusive Laboratory Evidence Of Human Immunodeficiency Virus: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group R75 includes inconclusive or indeterminate laboratory evidence of human immunodeficiency virus infection, capturing test results that suggest possible infection without confirmation. These ICD-10-CM diagnosis codes are used to document clinical scenarios where laboratory tests are ambiguous, requiring repeat testing, supplementary assays, or specialist follow-up to establish or rule out infection. Accurate coding within the ICD-10-CM R75 group supports proper claim adjudication, complete clinical documentation, and appropriate reimbursement for additional diagnostic and follow-up services.

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    ICD-10-CM R75: Inconclusive Laboratory Evidence Of Human Immunodeficiency Virus [HIV] Overview

    This group represents laboratory findings that suggest possible human immunodeficiency virus infection but are not definitive for diagnosis, targeting infectious disease and immunology testing of blood. It covers inconclusive or indeterminate serologic or virologic test results that require follow-up testing and clinical correlation. Accurate coding matters for reimbursement because it documents the need for additional diagnostic workup and guides claim adjudication for related laboratory and follow-up services.

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    When to Use

    Use a code from this group when laboratory testing yields indeterminate, equivocal, or otherwise inconclusive results for human immunodeficiency virus that have not been clinically confirmed. These codes apply when additional testing, repeat assays, or specialist consultation is planned to establish a definitive diagnosis.

    ICD-10-CM Codes

    1 rows

    ICD-10-CM CodeDescription
    R75Inconclusive laboratory evidence of human immunodeficiency virus [HIV]

    DRG Codes

    3 rows

    DRG CodeDescription
    814Reticuloendothelial and Immunity Disorders with MCC
    815Reticuloendothelial and Immunity Disorders with CC
    816Reticuloendothelial and Immunity Disorders without CC/MCC

    Typical Clinical Scenarios

    • An adult patient presents to an outpatient infectious disease clinic after routine prenatal screening or a routine occupational health screening returns a positive HIV antigen/antibody immunoassay followed by a negative or indeterminate confirmatory HIV-1/HIV-2 differentiation assay and pending HIV RNA (viral load) testing. Because the laboratory evidence is inconclusive and further testing is required to establish or exclude infection, a code from this group is assigned to document the unclear serologic status and need for follow-up. Typical codes: R75
    • A young adult with recent high-risk exposure (needlestick injury or unprotected sex) presents urgently for evaluation; initial fourth-generation HIV test yields reactive p24 antigen but the confirmatory antibody differentiation test is nonreactive and nucleic acid testing is ordered. The encounter is coded from this group to reflect inconclusive laboratory results while acute infection is being ruled out. Typical codes: R75
    • A patient with chronic conditions undergoes routine HIV screening prior to initiation of immunosuppressive therapy; the screening algorithm produces an indeterminate result (discordant screening and supplemental tests) without demonstrable viral RNA, prompting repeat testing and consultation before therapy proceeds. The inconclusive laboratory status is documented with a code from this group to indicate abnormal blood findings without a definitive diagnosis. Typical codes: R75

    Related Codes

    R70-ELEVATED-ERYTHROCYTE-SEDIMENTATION-RATE

    ICD-10-CM Code For Elevated Erythrocyte Sedimentation Rate And Abnormality Of Plasma Viscosity: Group Overview

    R71-ABNORMALITY-OF-RED-BLOOD-CELLS

    ICD-10-CM Code For Abnormality Of Red Blood Cells: Group Overview

    R73-ELEVATED-BLOOD-GLUCOSE-LEVEL

    ICD-10-CM Code For Elevated Blood Glucose Level: Group Overview

    R74-ABNORMAL-SERUM-ENZYME-LEVELS

    ICD-10-CM Code For Abnormal Serum Enzyme Levels: Group Overview

    R76-OTHER-ABNORMAL-IMMUNOLOGICAL-FINDINGS

    ICD-10-CM Code For Other Abnormal Immunological Findings In Serum: Group Overview

    R77-OTHER-ABNORMALITIES-OF-PLASMA-PROTEINS

    ICD-10-CM Code For Other Abnormalities Of Plasma Proteins: Group Overview

    R78-FINDINGS-OF-DRUGS-AND-OTHER-SUBSTANCES

    ICD-10-CM Code For Findings Of Drugs And Other Substances Not Normally Found In Blood: Group Overview

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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